Integrated Medical Education Resources: 140902P

Written and prepared by Professor Omar Hasan Kasule Sr.

Communication is fundamental to good medicine, the way doctors communicate can have long term outcome benefits[1]; for example Effective doctor communication reduces pre-operative anxiety and increases the patient’s satisfaction[2]. Good doctor patient communication increased elderly patient use of free drug samples[3].

Experience shows that doctor patient communication is not as effective as it should be. An Indonesian study revealed several problems in doctor-patient communication: the doctor patient relation was not participatory and doctors tended to be paternalistic[4]. Analysis of a videotape of an ophthalmology consultation revealed several negative communication modes: the interview was physician centered with physicians speaking 70% of the words, asking closed-ended questions that restricted the patient's contribution to "yes/no" or brief responses, and failing to identify patients who had missed doses of medication[5]. Research showed a communication gap between patients and gastroenterologists regarding the severity of symptoms and the nature of the functional diagnosis[6]. Communication between doctors and stroke victims was poor with negative consequences on disease management[7]. A need for more training in communication was expressed for radiologists[8]. Doctors and their patients have different perceptions of communication skills of doctors during interviews[9].

Gender, socio-economic status, and intellectual ability affect communication effectiveness. A literature review suggested that gender dyads affected interview length and content for example a female/female dyad has longer interview time. Doctor patient discussion of side effects of drug was affected by racial and income differences[10]. People with intellectual disabilities require special approaches to ensure effective communication for example physical examination has to be demonstrated before it is discussed[11].

Modern information and communication technology has been introduced in doctor patient communication with variable outcomes. Electronic medical records have both negative and positive effects on doctor patient communication: better information integration and processing but with impaired patient-centeredness[12]. Use of computers in doctor-patient interaction reduces eye contact, verbal and non-verbal contact[13]. Social media mediate and improve communication between patients and doctors[14]. Patients who looked up cancer related information on the internet has more effective communication with their doctors[15]. Health assessment questionnaires improve doctor patient communication[16].

A patient self- assessment tool can be used to assess doctor patient communication[17]. A 2-way communication check list improved doctor-patient communication[18]. Quantifying word use by patients and doctors can help in research to improve communication[19].

Narrative medicine is an expansion and improvement on the normal communication being a patient-centered holistic approach to talking to and listening to the patient[20]. Three factors were identified to improve communication: two-way communication, biopsychosocial content and nonverbal communication[21].

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